Abstract

Background: Primary angle-closure glaucoma (PACG) is a major cause of irreversible blindness worldwide, particularly in Asian populations. It represents the most severe form of primary angle-closure disease (PACD) and is characterized by obstruction of the anterior chamber angle, leading to elevated intraocular pressure (IOP) and glaucomatous optic neuropathy. PACG is often asymptomatic in early stages, resulting in delayed diagnosis and management. The article reviews the epidemiology, risk factors, pathophysiology, diagnostic approaches, and management strategies of primary angle-closure glaucoma.
Methods: This narrative review was conducted through a comprehensive literature search using PubMed, Scopus, Web of Science, Google Scholar, and ResearchGate. English-language articles published between 2018 and 2025 with available full texts were included. Additional studies were identified through cross-referencing.
Results: The global prevalence of PACG is increasing, with projections indicating a significant rise by 2040. Key risk factors include advancing age, female gender, Asian ethnicity, hyperopia, shallow anterior chamber depth, short axial length, and a thick, anteriorly positioned lens. The primary mechanisms involved in pathophysiology include pupillary block and anterior displacement of the iris, resulting in angle closure and increased IOP. Diagnosis is based on clinical evaluation, including patient history, intraocular pressure measurement, gonioscopy, and assessment of the anterior chamber angle. Imaging modalities such as ultrasound biomicroscopy and anterior segment optical coherence tomography improve diagnostic precision.
Conclusion: PACG remains a public health concern due to its high risk of blindness and frequent underdiagnosis. Early detection, appropriate diagnostic evaluation, and timely intervention are essential for reducing disease burden and preventing visual impairment.

Key words: Primary angle-closure glaucoma; intraocular pressure; anterior chamber angle; gonioscopy; pathophysiology; risk factors; epidemiology; diagnosis; management; glaucomatous optic neuropathy